Refinement of screening for familial pancreatic cancer

Abstract

It appears safe to start screening for PDAC in IAR of non-CDKN2a FPC families at the age of 50 years. MRI-based screening supplemented by EUS at baseline and every 3rd year or when changes in MRI occur appears to be efficient.

Pancreatic ductal adenocarcinoma in BRCA2 mutation carriers

“…The CAPS consortium guidelines recommend to start screening at the age of 50 years (Canto et al 2013) because the incidence of PDAC appears to be low in younger subjects. This was confirmed in the study by Bartsch et al (2016), in which high-risk individuals developing PDAC were not younger at the time of PDAC diagnosis than index cases, and with no significant lesions before the age of 50 years. Thus, although medico-economic studies are needed, screening before the age of 50 years may not be cost-effective in this setting , Canto et al 2013, Bartsch et al 2016.…”

“…This was confirmed in the study by Bartsch et al (2016), in which high-risk individuals developing PDAC were not younger at the time of PDAC diagnosis than index cases, and with no significant lesions before the age of 50 years. Thus, although medico-economic studies are needed, screening before the age of 50 years may not be cost-effective in this setting , Canto et al 2013, Bartsch et al 2016. Finally, although tobacco consumption increases the risk of PDAC in subjects with familial PDAC history, there is no recommendation for earlier screening in smokers.…”

“…The most widely accepted tools for PDAC screening are endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI) cholangiopancreaticography (Klapman & Malafa 2008, Canto et al 2013, Lu 2015, Bartsch et al 2016. The prevalence of small, mostly cystic, pancreatic lesions was 42.6 and 33.3% by EUS and MRI, respectively, in the CAPS3 study (Canto et al 2012).…”

“…In 2012, the International Cancer of the Pancreas Screening (CAPS) Consortium published guidelines on the management of patients with increased risk for familial PDAC (Canto et al 2013). The aim of screening is to detect and remove precancerous lesions such as multifocal high-grade pancreatic intraepithelial neoplasia (PanIN) lesions and IPMN with high-grade dysplasia (Shi et al 2009, Matthaei et al 2011, Lucas et al 2013 in patients eligible for pancreatic surgery (Klapman & Malafa 2008, Bartsch et al 2016.…”

A clinical prediction model to assess risk for pancreatic cancer among patients with new-onset diabetes.

“…The feasibility and cost-effectiveness of this approach has already been shown in recent screening protocols applied to members of families with familial pancreatic cancer (FPC) and patients with select germline mutations. [7][8][9][10][11] However, only 10-20% of all cases of PDA can be attributed to FPC; the vast majority of PDA arise sporadically with limited family history of this disease. 12 The epidemiological association between diabetes mellitus and PDA has been reported in numerous studies.…”